Related Experiment Video
Updated: Feb 26, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal physicians' perceptions of message framing when delivering serious news to parents: a randomised crossover
Hannah Stümer1, Fiona A Wocheslander1, Florian Hammerle2
1Division of Neonatology, Centre for Paediatric and Adolescent Medicine, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Insights
Neonatal physicians overwhelmingly preferred optimistic prognostic framing when discussing serious news with parents. This framing enhanced perceptions of parental preparedness and physician compassion, though it did not alter cognitive assessments of prognosis.
Area of Science:
- Neonatal Medicine
- Medical Communication
- Clinical Psychology
Background:
- Delivering serious news to parents about neonatal outcomes is challenging.
- Prognostic framing, the way information is presented, can influence perceptions.
- Understanding physician preferences for framing is crucial for effective communication.
Purpose of the Study:
- To investigate neonatal physicians' preferences for optimistic versus pessimistic prognostic framing.
- To assess the impact of framing on parental preparedness, physician professionalism, and compassion.
Main Methods:
- A multicentre, double-blind, randomised crossover study.
- Neonatal physicians viewed scripted videos with identical prognostic data but differing frames (optimistic vs. pessimistic).
- Evaluated framing preference, parental preparedness, physician attributes, and communication challenges.
Main Results:
- 86% of physicians preferred optimistic framing.
- Optimistic framing led to higher perceived parental preparedness and better physician evaluations (professionalism, compassion).
- Framing did not significantly alter perceptions of prognostic severity or optimism about survival/non-impairment.
Conclusions:
- Neonatal physicians show a strong preference for optimistic prognostic framing.
- Framing effects appear primarily affective, influencing emotional responses rather than cognitive assessments.
- This highlights implicit biases in neonatal prognostic communication.
Objective:
To examine neonatal physicians' perceptions of optimistic versus pessimistic prognostic framing when delivering serious news to parents.
Design:
Multicentre, double-blind, randomised crossover study.
Setting:
Conducted online between February and April 2022 at the University Medical Centre Mainz, Germany.
Participants:
Neonatal physicians from tertiary perinatal centres in Germany, Austria, Switzerland and Italy.
Intervention:
Participants viewed two scripted videos of a physician-parent conversation about a very preterm infant with severe intraventricular haemorrhage. Both conveyed identical numerical prognostic estimates but differed in framing: emphasising survival without disability (optimistic) or risk of death and impairment (pessimistic).
Main Outcome Measures:
Primary outcome was framing preference. Secondary outcomes included Likert scale ratings of parental preparedness, physician professionalism and compassion, prognostic severity and optimism regarding survival and non-impairment, as well as free-text comments on challenges in prognostic communication.
Results:
Of 115 participants, 99 (86%) preferred the optimistic video (period-corrected preference odds (95% CI): 8.6 (7.4 to 9.7)). Optimistic framing was associated with higher ratings of parental preparedness and more favourable evaluations of the consulting physician, including professionalism and compassion, but had no effect on perceived prognostic severity, or optimism about survival or non-impairment. Communication was frequently described as an interpersonal challenge, involving the difficulty of maintaining trust, empathy and hope while communicating under prognostic uncertainty.
Conclusions:
Neonatal physicians strongly preferred optimistic framing. Framing effects were primarily affective rather than cognitive and highlight implicit and complex framing biases in neonatal communication.
Trial Registration Number:
German Clinical Trials Register (DRKS), www.drks.de/DRKS00024466.
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